RN Medical Reviewer II - Palmetto GBA-13

Position Purpose: Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.

Location: This is a full-time, salaried position, Monday–Friday, in a typical home office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00 AM–5:00 PM ET. It may be necessary, given the business need, to occasionally work additional hours. This position is Work at Home. You must have high-speed (non-satellite) internet service and a private home office to work from home.

Sponsorship: This position is not eligible for sponsorship now or in the future. To Qualify For This Position, You'll Need The Following: Associate's degree in a job-related field Degree Equivalency: Graduate of Accredited School of Nursing 2 years clinical experience Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Microsoft Office Active RN licensure in the state of hire, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC). Our Comprehensive Benefits Package Includes The Following: Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more

Equal Employment Opportunity Statement: BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.